Shelby Rae Jimenez, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

116806 Issued in AK

Practice address

3190 E Meridian Park Loop Ste 206a
Wasilla, AK 99654-7422

Phone

(907) 373-9462

Fax

(907) 373-9463

NPI assigned

Aug 20, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Specialty

Physical Therapist in Private Practice

Education

Other, 2016

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Medical Group of Alaska

  • Physical Therapy Clinic/Center
  • Wasilla, AK
  • NPI 1891208351
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1534723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534723200000",
    "number": "1720568611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4130 N PRESTON AVE",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996541352",
            "telephone_number": "907-414-4392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3190 E MERIDIAN PARK LOOP STE 206A",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547422",
            "telephone_number": "907-373-9462",
            "fax_number": "907-373-9463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIMENEZ",
        "first_name": "SHELBY",
        "middle_name": "RAE",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-20",
        "last_updated": "2018-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "AK",
            "license": "116806",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Constance M. Jerz, DC
• Rebecca Lynn Jessop-Christensen, LMT, CLT
• Rebecca Faye Jett
• Zoey Rae Jewell, RBT
• Mary Kate Jimenez
• Job Ready, Inc
• Job Ready, Inc.
• Job Ready, Inc.
• Joey'S Place LLC
• Sarah Wood Johanson, MSN, ACNP-BC, RNFA

• Physical Therapy Assistant in Wasilla, AK
• Providers in Wasilla, AK by specialty
• Physical Therapy Assistant in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.